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HomeMy WebLinkAbout0850 FALMOUTH ROAD/RTE 28 Aso r-al Y-na , u, , r � r Town of Barnstable Building ax*srs$cc Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Posted UntiljFinal;lnspection Has Been Made. .ass .m � s Where a Certificate';of Occupancy'is Required,such Building stall Not;be Occupied until a Final Inspection has been made. erm Permit No. B-19-1572 Applicant Name: John T. Norman Approvals Date Issued: 05/15/2019 Current Use: Structure Permit Type: Building-Demolition Expiration Date: 11/15/2019 Foundation: Location: 850 FALMOUTH ROAD/RTE 28, HYANNIS Map/Lot: 2507036 Zoning District: MAH Sheathing: Owner on Record: LORUSSO, L&THOMPSON, M& MURRAY,E Contractor Name: John T. Norman Framing: 1 Address: LYNDON PAUL CHAR FOUNDATION Contractor,License: CS-089842 2 .... HYANNIS, MA 02601 Est. Project Cost: $60,000.00 Chimney: Description: DEMOLISH THE EXISTING SINGLE COMMERCIAL STRUCTURE Permit Fee: $546.00 (BLOCK,WOOD AND STEEL INC. FOUNDATION) REMOVE FROM THE Insulation: 'Fee Paid`. $546.00 SITE AND DISPOSE OF PROPERLY Final: Date: 5/15/2019 Project Review Req: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT E ~�• Application Number. ...��.�....I5......................... BARMA19A s � A Y MA88. `40 0•````� Permit Fee.......................................Other Fee........................ 03 TotalFee Paid............ ................................................ ...... TOWNOF BARNSTABLE Permit Approval by.................................On........................... BUILDING PERMIT Map........a,. ...............Parcel.......03. ..................... APPLICATION Section 1 — Owner's Information and Project Location Project Address—, at,,-*u-ry lA%..aA , illage b¢�y-a-+� ,•�a s Owners Legal Address_ S �rJ.S d. (��A-, City- State> ,�lAA �-Zip Owners Cell* :50V=-7-M--SOSM E=mail (—' M S c9 <5- bA-444a W . Crery►� Section.2 --Use-of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use D (entie stracttire)- ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar ❑ Renovation ❑ Pool ❑ Insulation Other-Specify 4 LSeetion 4-W6rk_Deesscription'. Last undated: 11/15/2018 i 1. Application Number.................................................... ' 1 Section 5—Detail .Xi Cost of Proposed Construction , 0 OOd— Square Footage of Project Age of Structure Dig Safe Number L # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone�Compliance Method.:0 MA Checklist ❑ WFCM Checklist ❑ Design i a Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private f Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. 1 Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board.in the past? E Yes ❑ No Last updated. 11/15/2018 The Town of Barnstable Department of Public Works 382 Falmouth Road,Hyannis,MA 02601 p��� �+pDT BAMffrAJMF �t1tUV�1C1llL KAS& www.town.bamstable.ma.us 639-2014 375 for +° Daniel W. Santos,P.E. Office: 508.790.6400 Director Fax: 508,790.6343 April 21 , 2019 Subject : 850 Falmouth Road ; Hyannis village Map & Parcel 250 - 036 Disconnection from Municipal Sewer Dear Sirs; This is to notify you that the commercial biulding, located at 850 Falmouth Road, ( Map & Parcel 250 - 36 ) , in the village of Hyannis, was disconnected from municipal sewer on April 2nd , 2019. The disconnection was inspected & accepted by the Construction Projects Inspector from the Town of Barnstable DPW - Admin & Tech Support. If you have any questions, or need additional information, please contact Dave Anderson at 508 - 294 - 2800 . Sincerely; David nderson Town of Barnstable DPW Admin & Tech Support I� orrt++E r Department of Public Works 47 Old Yarmouth Rd. P.O.sox 326 Water Supply Division Hyannis,MA. 02601-0326 sAMS?ABLE,NAM TES:508-775-0063 ', t� Hyannis Water System Operations FAX:508-790-1313 April 23, 2019 Town of Barnstable Building Department Brian Florence, CBO Building Commissioner 200 Main Street, Hyannis MA 02601 RE: 850 Falmouth Rd, Hyannis-Account# 600440-1 Dear Sir: Please be advised that the above water service was shut off and the meter removed. The water service at the above address was cut and capped on 4-16-2019. If you have any questions, please call the Hyannis Water Systems office at (508) 775-0063 x 3524. Sincerely, Donna L. Caperello Hyannis Water System I 247 Station Dr.,Westwood,Massachusetts 02090.9230 EVERSSWRCE ENERGY 2/20/19 Dan Meehan 850 Falmouth Rd. Hyannis, MA 02601 RE! —850 Falmouth Rd.; HYA Dear Mr. Meehan, This letter will serve as confirmation that there is no electric service'at 850 Falmouth Rd., HYA. The power has been inspected by and no electric existing at the facility. Based on this information, there is no electric power to this building and you may proceed with the.demolition. If you have any questions, please contact me at(781)441-8630 Sincerely, ". #070 Sean M. Hayes Eversource COO NewTemplate national airad February 14, 2018 MO-Falmouth Rd. Hyannis This letter is to notify you that after our investigation it has been determined that the gas service 850 Falmouth Rd,Hyannis was found to be cut-off on 12/08/2010. This letter DOES NOT preclude the excavator or homeowner from calling,811 before commencing any work. State law requires anyone planning underground excavation work to notify local utilities by calling 811 to getyour underground lines identified for you prior to doing any digging. The call to 811 is the LAW and must be made in advance of starting work.This confirmation letter of a gas cut-off DOES NOT relieve the excavator of making_the call to'811. It,is a State Law.requirement. If you have any questions, please feel free to contact me at 781-907-3728 Thank you, Colin Galvin nationalgrid Gas Connections colin.galvin@nationalgdd.com 781-907-2958 AT&T-CLll0by46-22 3/1J/201U 8 : 46: b8 AM PAGE 2/002 Pax berver FROM: AT&T Long Distance Cable Protection Center GFI This is to notify you about status of received tickets. This does not mean that another utility other than AT&T Long Distance is clear OR that future and/or different activities at the same location would be clear. This message does not include any AT&T cable formerly known as SBC, Bell South or TCG. If you have any questions about this message or if you believe you have received this notification in error, and that AT&T cable is actually in the vicinity of your excavation activity, please call 1-800-252-1133. Locate requested by BORTOLOTTI CONST INC to the Dig Safe Systems One-Call Ticket Message Number: 20191203579 Closed with status: AT&T is clear. Ticket was processed by GFI AutoScreener AT&T Reference Number: 46737646 work Date & Time: Mar 22 2019 8:45AM work Location: 850 FALMOUTH RD, BARNSTABLE MA Near intersection: UKN PER CALLER -y Legend ❑ Parcels _ - - Town Boundary Railroad Tracks Roads 1. r�^7 O Paved Road J — i C3 Unpaved Road ED -�7! i 0 Bridge Paved Median r f'`r � � "' 0 Water Bodies :� J / t_ =aR !!! ' -`a, r rl+� Ir e ~W.W. ,�'--�� L�j f+��\ If ���-�y �t + ' 'Y„ f ?��-�7?r� �� -- � r !• i � �. -"4 AX '•,tad __111_�Z_ r M' � Map printed on: 3/26/2oig This map is for illustration purposes only.It is not Parcel lines sho-Am on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA o26oi 0 667 1,333 an on-the-ground survey.It maybe generalized,may not accurate relationships to physical objects on the map 50 8-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale: 1 inch= 66'7 feet cartographic errors or omissions. gis@town.barnstable.ma.us Property Print Page 1 of 4 Print this page Owner Information Map/Block/Lot: 250 /036/ Property Address 850 FALMOUTH ROAD/RTE 28 Village: Hyannis Town Sewer At Address: Yes GIS Zoning Value: MAH Owner Name as of 1/1/18: LORUSSO, L & THOMPSON, M & MURRAY, E & LYNDON PAUL CHAR FOUNDATION PO BOX 1776 HYANNIS, MA. 02601 Co-Owner Name COURT, C & A TRS Assessed Values Appraised Value Assessed Value Building Value $ 508,200 $ 508,200 Extra Features $ 55,300 $ 55,300 Outbuildings $ 22,800 $ 22,800 Land Value $ 397,200 $ 397,200 Totals $ 983,500 $ 983,500 Past Comparisons 2018 - $ 955,000 2017 - $ 955,000 2016 - $ 955,000 2015 - $ 1,088,200 :. 2014 - $ 1,174,600 2013 - $ 1,174,600 2012 - $ 1,237,300 2011 - $ 1,331,900 2010 - $ 1,360,700 2009 - $ 2,278,800 Tax Information https://townofbarnstable.us/Departments/Assessing/Property_Valties/print 19.asp?ap=0&s... 3/26/2019 Property Print Page 3 of 4 BAS 113��T11 . l�D.e � �•` III 50 'BMT BASS; 0 BAS BMT ry 56 BMT 5E55 b0 I B- BMT ` AsBuilt Card N/A B2N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor, Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area(Unfinished) FUS Second Story Living Area SPE Pool Enclosure (Finished) BRN Barn GAR Garage TQS Three Quarters Story(Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine, Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in Porch PRT Portico WDK Wood Deck PTO Patio Construction Details Building Details Land Building value $508,200 Bedrooms 01 USE CODE 3040 Replacement Cost $1,449,477 Bathrooms 0 Full-0 Half Lot Size(Acres) 2.98 Model Commercial Total Rooms Appraised Value $397,200 Style Nursing Home Heat Fuel Oil Assessed Value $397,200 E Grade Economy Heat Type Hot Water !� https://townofbarnstable.us/Departments/Assessing/Property_Values/print 19.asp?ap=0&s... 3/26/2019 Property Print Page 4 of 4 Year Built 1967 AC Type None Effective depreciation Interior Floors Hardwood Stories 1 Interior Walls Plastered Living Area sq/ft 21,522 Exterior Walls Stucco on Wood Gross Area sq/ft 43,464 Roof Structure Flat Roof Cover Tar&Gravel Outbuildings and Extra Features Code Description Units/SQ ft Appraised Value Assessed Value BMT Basement-Unfinished 21522 $53,500 $53,500 FGPL Flagpole-25' 1 $2,200 $2,200 FOPC Open Prch-roof, 420 $ 1,800 $ 1,800 ceiling PAV1 PAVING-ASPHALT 14000 $20,600 $20,600 https://townof barnstable.us/Departments/Assessing/Property_V alues/print_19.asp?ap=0&s... 3/26/2019 r Property Print Page 2 of 4 Hyannis FD Tax(Commercial) $ 4,809.32 Hyannis FD Tax (Residential) $ 0 Community Preservation Act Tax $ 254.04 Town Tax (Commercial) $ 8,467.94 Town Tax (Residential) $ 0 $ 13,531.30 Sales History Owner: Sale Date Book/Pa e: Sale g Price: LORUSSO, L & THOMPSON, M &MURRAY, E & 2011-01-28 25220/34 $1 THOMPSON, MARK W TR 2005-11-04 20443/53 $1100000 CAPE & ISLANDS NURSING HOME 1987-10-15 5971/94 $3400000 HEALTH CARE PROPERTY INVEST 1986-06-15 5158/281 $3300000 COLUMBIA HEALTHCARE 1985-11-15 4808/44 $3150000 WHITEHALL MANOR NRS HM INC 1965-10-14 1314/683 $0 Photos Sketches https://townof barnstable.us/Departments/Assessing/Property_V alues/print_19.asp?ap=0&s... 3/26/2019 Page 1 of 2 f ilk -Y- i r b _ : r 7 t:.4 .-' w a� �.i"+"�'`a.���4*' �Yi�j+'�A7 �+(q, �+.�„i r W s� 'y�+i r*•". f-r_'.,3 �} yS •^7,4' !o^"'�/, � S1..A d�N. f. w ; 4' a Yr�i « i' '4 i � � , r. �� g*r�� v r � a�"' < � _y���',!=�w7�'q4 � Ste.. � -•� � r'�, �f��ii - � 5S ��''✓"'�1�+fib iEiJj'��IAf ar 4 i '� 4 is .1 t a https://townofbarnstable.us/propertyimages/00/25/25/42.jpg 3/26/2019 Page 2 of 2 «a.a "� r'.44 f LA + a.. `y https://townofbarnstable.us/propertyimages/00/25/25/42.jpg 3/26/2019 r A� CERTIFICATE OF LIABILITYDATE /26/2/YYYY) I1��l�@�A�CE 03262019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer ri hts to the certificate holder in lieu of such endorsements. PRODUCER CONTACT FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER PHOHOME OFFICE: P.O.BOX 328 A CNNo Ext:888-333-4949 n/c No):507-4464664 OWATONNA, MN 55060 ADMDRESS:CLIENTCONTACTCENTER FEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 173-624-8 INSURER B: BORTOLOTTI CONSTRUCTION,INC. INSURER C: 45 INDUSTRY RD MARSTONS MILLS,MA 02648-1737 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:174 REVISION NUMBER:0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DL SUER POLICY NUMBER POLICY EFF POLICY EXP LTR INSR WVD MMIDDIYYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE DAM AGE TO RENTED $100,000 OCCUR REMISES Ea o.curre ce MED EXP(Any one person) EXCLUDED A N N 6086233 03/07/2019 03/07/2020 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ❑PRO ❑LOC NOTHER: PRODUCTS•COMPIOP AGG $2,000,000 JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Me accident) $1,000,000 X ANY AUTO BODILY INJURY(Per person) SCHEDULED OWNED AUTOS ONLY A AUTOS N N 6086232 03/07/2019 03/07/2020 BODILY INJURY(Per accident) HIRED AUTOS ONLY NON-OWNED AUTOS ONLY PROPERTY DAMAGE Per ccident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $5,000,000 A EXCESS LIAB CLAIMS-MADE N N 6086235 03/07/2019 03/07/2020 AGGREGATE $5,000,000 DED I I RETENTION WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY Y/N X PER STATUTE 7 ER ANY PROPRIETORIPARTNERIEXECUTIVE D E.L.EACH ACCIDENT $1,000,000 A OFFICER/MEMBER EXCLUDED? NIA N 6086236 03/07/2019 03/07/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION 173-624-8 - 1740 COMMONWEALTH OF MASSACHUSETTS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DEPT OF INDUSTRIAL ACCIDENTS THE EXPIRATION DATE THEREOF, NOTICE WILL, BE DELIVERED IN 600 WASHINGTON ST ACCORDANCE WITH THE POLICY PROVISIONS. BOSTON,MA 02111-1704 AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Deparhninnt of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Binders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Naive(Business/Organization/Individual): 601A-Vl ow �- Address: '45.T-rJt,L r�4 V-J City/State/Zip: ,ar,565 1s Mg ()�4q$ Phone#: Svc `7/ - �7`3` 9 Are on an employer?Check the appropriate box: Type of project(required): 1.2I am a employer with- Al 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. . 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insuranceJ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner do' all work officers have exercised their 11. Plumb' r � right of exemption per MGL ❑ � ��or additions myself [No workers comp. p p 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required-] *Any applicant that checks box A must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. ������ � I I Cl Insurance Company Name: �i �v�S �' vVirl Policy#or Self-ins.Lic.#: Expiration Date: Lo 17 -J.-a a 0 Job Site Address: 0 ! — /S City/State/Zip: t{ 74 D3-0-/ Attach a copy of the workers'compensation policy declare on page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th a 4 nalties of perjury that the information provided above is true and correct. Signature: '' � Date: 01JL�/ 9 Phone#: U$-'771 `- /3 5;7 0)fk1al use only. Do not write in this area,to be completed by city or town ofJ`icia[ City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: - Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written.» An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other,legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shaII withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance ' requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application-for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below..Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 4 Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commdmwealth of Massachusefts Department of Industrial Accidents Office of hnvestigatians 660 Washington Street Bostoma MA 02111 1 - Tel.#617-727-4400 ext 406 or 1-877-MASSAFE Revised 42407 Fax#617-727-7749. www.masi.gov/dia Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction'Supervisor CS-089842 E-zpires: 01/02/2020 x JOHN T.NORMAN � PO BOX 1494% ' z MARSTONS MILLS MA`02648, Commissioner CL Supervisor Which contain 1 Construction use group of enclosed Buildings of any Meters) ` unrestricted- 991 cubic 000 cubic feetpace. less than 35, 1 i I I ss a current edition of the Massachusetts y Failure to_pgsse of this license. Code is cause for revocation. State Building nation about this license Call(For infor3 0o or visit WW)N 721- 61T) - BORTOLOTTI CONSTRUCTION INC. DRAINAGE LAND DEVELOPMENT SEPTIC SYSTEMS May 9,2019 Town of Barnstable 200 Main Street Hyannis,MA 02601 RE: 850 Falmouth Road—Hyannis,MA Demolition y To Whom It May Concern, John Norman is an employee of Bortolotti Construction,Inc. and has been employed by Bortolotti Construction,Inc.for over ten years. He is currently employed in a management position and will be managing the demolition of 850 Falmouth Road,Hyannis. Sincerely, Robert J.Bortolotti,President W Bortolotti Construction,Inc. a m WC�j co Q D N �7 ^ CC -- 0 ~ CIO O c 0 P.O. BOX 704 • MARSTONS MILLS, MASSACHUSETTS 02648 • (508) 771-9399 • FAX(508)428-9399 bortolotticonstruction@verizon.net Application Number........................................... Section-9—=-Construction Supervisor Name, O 41 r,, 6 r A4414 Telephoned Number �Acidress'//jZS©JD�f'©=����City��G/•�jl'1lS State Zip 12 0--Z� V5 License-Number 5_0 F�Micense Type /Z/z® Zo Cd-n- actoffEiisail­ ' Cell # I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation re ed 780 CMR an Town of Barnstable.Attach a copy of your license. , �Signat rem Dates �i /(9 i Section 10—Home Improvement Contractor k - Name Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date J "r-PLICAN_T_:SIGNATURE, Signature) Date _. S/I A/9 fPTint Name Telephone Number B-mall.permit to:-� (� x�-'o (�tt i s��`�cfi o c� c� pit 1znu.� , W Z7— Last updated. 11/15/2018 Section 12 Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval. , Section _3_Owners Authorization ci , M.Sa -rt. W =0as, Owner of the subject property hereby authorize r fj c_ to act on my behalf, in all matters relative,to work_ _authorized by.this building permit application for: Twz � , RVA.aM S. tip' ddress of job) c Signature ofOwner date Prin � arise~'' . Last updated: 11/152018 j :A Of BA s CAPE COD COMMISSION p 3225 MAIN STREET P.O. BOX 226 BARNSTABLE, MA 02630 �ssACHUSti� (508)362-3828 FAX(508)362-3136 E-mail:frontdesk@capecodcommission.org Date: December 17, 2009 To: Attorney Ron Jansson P.O. Box 147 Barnstable, MA 02630 From: Cape Cod Commission RE: Notice of Intent to File a Development Agreement application Cape Cod Commission Development Agreement Regulations Barnstable County Ordinance 92-1, Section 5 Applicant: Lyndon Lorusso Charitable Foundation of 2002 and Independence Park, Inc. Mr. Mark Thompson Chairman of the Board, Lyndon Lorusso Charitable Foundation of 2002 President, Independence Park, Inc Project: The Village at Barnstable Project Number: DA09016 Location: Part One: Communication Way,.Independence Park, Hyannis, MA Part Two: 850 Falmouth Road, Hyannis, MA (former Manor Nursing Home) Map & Parcel: Communication Way Location Map 314, Parcels 36, 37, 38, 44, 45, 46, 47, 48 and 49 C850=Falmouth Road, Hyaiiriis;;MA Map 315; Parcel 42 Registry Information: Communication Way Parcels: Book 21617 Page 232 850 Falmouth Road Site: Book 20443 Page 53 PROPOSED PROJECT The proposed project is the construction and operation of a 340-unit continuing care retirement community located on a 25.88-acre site in Independence Park, Hyannis, MA. The proposed project would be constructed in at least three phases as funding allows, and at build-out would consist of six buildings for a total of 738,970 square feet. The project includes independent CIO r' living units (configured to allow for assisted living care), a 60-bed skilled nursing facility, an underground parking garage, and on-site amenities, such as a bank, dining facility, fitness center, and auditorium. The affordable housing component is proposed to be located off-site at 850 Falmouth Road, Hyannis, which is the site of the former Manor Nursing-Home. DECISION OF THE CAPE COD COMMISSION In accordance with Section 5 of the Cape Cod Commission Development Agreement Regulations, Barnstable County Ordinance 92-1; (Regulations)the Cape Cod Commission (Commission) hereby approves The Village at Barnstable's Notice of Intent to File a Development Agreement application and determines that the proposed development, including both the Communication Way and 850 Falmouth Road locations, is suitable and qualifies to be the subject of a Development Agreement. This decision is rendered pursuant to a vote of the Commission on December 17, 2009. On November 9, 2009,the Regulatory Committee of the Commission voted unanimously to recommend to the full Commission that the proposed development, including both the Communication Way and 850 Falmouth Road locations, is suitable and qualifies for consideration'as a Development Agreement with the Commission. The Commission fmds that the proposed development, including both the Communication Way and 850 Falmouth Road locations, is suitable and qualifies for the Development Agreement process. In accordance with said Regulations, the Qualified Applicant shall have one year from the date of this determination decision to file a Development Agreement application with the Commission and to pay the applicable fee in accordance with the Commission's Enabling Regulations, Barnstable County Ordinance 90-12, as amended. Commission Chair Date COMMONWEALTH OF MASSACHUSETTS Barnstable, ss 2009 Before me,the undersigned notary public, personally appeared /Z©cldell irG6ee,PzJ,r; ter , in his/her capacity asnMairman of the Cape Cod Commission, whose name is signed on the preceding document, and such person acknowledged to me tha he he signed such document voluntarily for its stated purpose. The identity of such person was proved to me through satisfactory evidence of identification,which was U photographic identification with signature issu d by a federal or state governmental agency, U oath or affirmation of a credible witness, or personal knowledge of the undersigned. Notary Public My Commission Expires: Decision—Notice of Intent—December 17,2009. The Village at Barnstable Continuing Care Facility Page 2 of 2 � CAPE COD COMMISS of 8 %OF$ BARNSTAS CE a O _ 3225 MAIN STREETS DEC 22 P�1 P.O. BOX 226 1: 49 BARNSTABLE, MASSACHUSETTS 02630 9�SACHUStiS (508) 362-3828 FAX (508) 362-3136 E-mail: frontdesk@capecodcommissiop.bvj ZJ®N TO: Town of Barnstable Town Clerk,Building Inspector, Town Planner, Planning Board,Board of Appeals, Conservation Commission, Board of Health and Police Chief FROM: Gail Hanley, Clerk of the Commission SUBJECT: The Village at Barnstable Notice of Intent to File a Development Agreement Decision DA09016 DATE: December 21, 2009 Enclosed please find a copy of the Decision for The Village at Barnstable Notice of Intent to File a Development Agreement that was approved by the Cape Cod Commission on December 17, 2009. Should you have any questions, please do not hesitate to contact our office. - i L�1 f